Collaborative Arrangement laws abolished, more nurses to work to full scope

Legislation to remove Collaborative Arrangement laws that will allow nurse practitioners and endorsed midwives to work to their full scope of practice came into effect last Friday.

Scrapping the restrictive arrangements, which have been in place since 2010, means more experienced nurses will be able to deliver healthcare services autonomously.

The laws have historically prevented nurses from providing Medicare subsidised services and prescribing certain medications available on the Pharmaceutical Benefits Scheme (PBS) without a supervising medical practitioner.

The Health Legislation Amendment (Removal of Requirement for a Collaborative Arrangement) Bill 2024 was introduced to Parliament in March this year, in the hopes that it would expand both the accessibility and affordability of high-quality healthcare, particularly for those living in rural and remote areas.

The Bill also contributes to parallel Labor government initiatives such as the Nurse Practitioner Workforce Plan and Strengthening Medicare measures.

The Bill was passed in the Senate on May 17, despite opposition from the Royal Australian College of General Practitioners (RACGP) and the Australian Medical Association (AMA).

In a joint press conference last week, Health Minister Mark Butler and Health and Aged Care Assistant Minister Ged Kearney said it was an "auspicious day."

“This really opens up the doors for endorsed wives and nurse practitioners to operate independently, to set up their own small businesses, to provide very best care to the community that we possibly can," Assistant Minister Kearney said.

“It’s great news for the community because it means increased access to healthcare at a time when we know that many people are struggling to get timely healthcare, particularly in our rural and regional areas, but also here in our cities.” 

Australian College of Nursing chief Adjunct Professor Kathryn Zeitz FACN called the removal of the laws is a "big win" for patients.

“It will have a significant positive impact on health service delivery, especially for those who live in rural, regional, and remote communities, and other underserved communities,” Adjunct Professor Zeitz said.

“The removal of collaborative arrangements will provide nurses and midwives with much-deserved respect and acknowledgement of their clinical expertise.

“We hope this landmark change will help attract more Registered Nurses to become Nurse Practitioners, and more Midwives to become Endorsed."

While many within the healthcare sector have praised the ministers for the initiative, the nation's medical peak bodies are concerned the move will discourage cooperation and potentially place patients at risk.

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The AMA expressed "significant disappointment" at the federal government's decision upon the announcement in March, citing concerns for that it would lead to a "fragmented, siloed approach to healthcare."

“Team based models of care are the future of healthcare, with safety and quality underpinned by close collaboration between health professionals and strong clinical governance,” said Professor Steve Robson, who was AMA president at the time, in a letter to Minister Butler.

“Collaborative practice with midwives is a key part of how we deliver care in my own specialty.

“The planned removal of collaborative arrangement provisions that are intended to guarantee this, combined with the absence of any robust framework to operate in their place, will promote a siloed approach to care and is contrary to the original stated intent of the reforms. It is also contrary to the expert clinical advice of the MBS Review Taskforce.”

However, as College of Nurses chief Leanne Boase pointed out, the removal of collaboration laws is as much about the workforce as it is about more people accessing healthcare subsidies.

"[The public] will have access to the entitlements that they already pay for through the tax system. They will have access, particularly people who are struggling to access healthcare, will have better rebates, Medicare rebates available, and more medicines will be subsidised," she said.

"Nurse practitioners and endorse midwives will continue to work the same way clinically ... however, they will no longer need this collaborative arrangement in order for people to access subsidies, and that's a crucial point."

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